Vestibular Schwannoma Koos Grade I International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study.
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Bin-Alamer Othman, Abou-Al-Shaar Hussam, Peker Selcuk, Samanci Yavuz, Pelcher Isabelle, Begley Sabrina, Goenka Anuj, Schulder Michael, Tourigny Jean-Nicolas, Mathieu David, Hamel Andréanne, Briggs Robert G, Yu Cheng, Zada Gabriel, Giannotta Steven L, Speckter Herwin, Palque Sarai, Tripathi Manjul, Kumar Saurabh, Kaur Rupinder, Kumar Narendra, Rogowski Brandon, Shepard Matthew J, Johnson Bryan A, Trifiletti Daniel M, Warnick Ronald E, Dayawansa Samantha, Mashiach Elad, Vasconcellos Fernando De Nigris, Bernstein Kenneth, Schnurman Zane, Alzate Juan, Kondziolka Douglas, Sheehan Jason P
Аннотация
METHODS: In a multicenter study, we retrospectively analyzed data of patients with Koos grade I VS who underwent SRS (SRS group) or were observed (observation group). Propensity score matching was used to equilibrate demographics, tumor size, and audiometric data across groups. The outcome analyzed included tumor control, preservation of serviceable hearing, and neurological function.
RESULTS: The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared with observation, with a 100% control rate at both 5- and 8-year marks in the SRS group vs 48.6% and 29.5% in the observation group at the same time intervals, respectively ( P < .001). Preservation of serviceable hearing outcomes between groups showed no significant difference at 5 and 8 years, ensuring a comparable quality of auditory function (SRS 70.1% vs observation 53.4% at 5 years; P = .33). Furthermore, SRS was associated with a reduced likelihood of tinnitus (odds ratio [OR] = 0.46, P = .04), vestibular dysfunction (OR = 0.17, P = .002), and overall cranial nerve dysfunction (OR = 0.49, P = .03) at last follow-up.
CONCLUSION: SRS management of patients with Koos grade I VS was associated with superior tumor control and reduced odds for cranial nerve dysfunction, while not compromising hearing preservation compared with observation. These findings support the safety and efficacy of SRS as a primary care approach for this patient population.